Provider behavior is another major determinant of adolescent's satisfaction with health care (12,29-34). A professional interested in adolescent problems was perceived by adolescents as another major attribute of an adolescent-friendly practice, second only to confidentiality (11). Freed et al. have found that adolescents' satisfaction with their visits may be more influenced by the interpersonal style of the health care provider than with the content of their actual discussions (31). However, young people (including those with JIA) have reported that health professionals should also be highly knowledgeable about their condition and highly rated the knowledge of their current staff (10,17,30,34).
Of all the interpersonal characteristics, honesty and trust are rated as key attributes of quality health care, regardless of the population under study (10,17,30,34). Adolescents have suggested that honesty includes "straight talk" which does not include condescension and false reassurance (30). Young people's requests for complete explanations of prognosis and treatment options have been documented previously (11,12,17,35-37). Unfortunately, both health professionals and parents may act, deliberately or inadvertently, as "gate-keepers" in the transmission of information (9,17,35,27). While this is often motivated by a desire to protect young people from emotional distress, it can impede effective communication of information. Other factors influencing communication between young people and professionals are detailed in Table 2 (9,21,38).
Adolescent health care provision is by definition multidisciplinary and potentially involves a wide range of professionals Table 3.
Effective communication by and among members of the virtual adolescent rheumatology team is a key principle of quality adolescent health care provision, acknowledging the recognition of confidentiality. These professionals should also be appropriately trained in adolescent health, a criterion not without its challenges considering the lack of formal training opportunities outside the mental health area currently available in the United Kingdom at the time of writing (39). Training issues with respect to adolescent rheumatology are discussed further in Chapter 17.
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